News
December 2011 Monthly Advocacy Update
2012 promises to be active and challenging. Congress is scheduled to reconvene on January 23, while 40 state legislatures start sessions this month. Battles over federal spending and deficit reduction are expected to dominate the Congressional agenda while states continue to struggle with meeting their own budget targets. The Affordable Care Act will remain top of mind, with the Supreme Court taking up the issue in March even as implementation continues with regulatory and legislative activity at the federal and state levels. The tobacco industry will continue to push back against efforts to protect public health, seeking to undermine existing protections or defeat attempts to enact new ones. All this comes against the backdrop of the 2012 election.
As always, ACS CAN is prepared to meet these challenges head on, with an ambitious agenda backed up by dedicated and hard working volunteers and staff. ACS CAN will be there -- fighting for funding for cancer-related programs and services; ensuring cancer patients and their families have improved access to quality, affordable health care; and protecting the public from the deadly effects of tobacco use. ACS CAN is fighting for the right causes for the right reasons - to put an end to cancer. I am confident of continued success in 2012 and I am grateful for your help in fulfilling our lifesaving mission.
CANCER RESEARCH AND PREVENTION PROGRAMS
Appropriations
On December 17, Congress passed an omnibus spending bill for the 2012 fiscal year (FY 2012) that includes a nearly $300 million increase in research funding for the National Institutes of Health (NIH) and also protects funding at the Centers for Disease Control and Prevention (CDC), which houses a number of important cancer prevention and control programs. This is an extraordinary achievement in a year that began with draconian cuts to cancer research and prevention, as well as the elimination or consolidation of CDC cancer control programs were on the table.
ACS CAN advocates nationwide deserve much credit for the victory thanks to a sustained campaign to persuade Congress to make funding for cancer research a priority. Highlights of the ongoing campaign included the annual Leadership Summit and Lobby Day, phone calls, emails, grassroots events, events at cancer centers in Alabama, California, Texas, and second national television ad. ACS CAN also worked closely with its partners in One Voice Against Cancer (OVAC), participating in a record three lobby days in 2012 and signing onto several letters to Congressional leaders. Clearly, Congress heard the voices of real people -- volunteers in every community across the nation -- telling them the terrible impact that cuts could have in the fight against cancer. Read the ACS CAN press release.
While ACS CAN is pleased with the outcome and hope it is indicative of a long-term commitment by Congress to fight cancer, 2012, battles over federal spending and the size of the deficit are expected to continue unabated in 2012. ACS CAN will remain vigilant in its work to stave off potentially devastating cuts to cancer research in the future, keeping the pressure on Congress to make funding for cancer research and prevention a priority.
National Cancer Act
December 23 marked the 40th anniversary of President Richard Nixon's signing of the National Cancer Act, effectively declaring "war on cancer" and reinvigorating the fight against the disease. Click here to view a video with archival footage of the signing and to hear Dr. John Seffrin, chief executive officer of the American Cancer Society and ACS CAN, and Dr. Otis Brawley, the Society's chief medical officer, reflect on what the signing of the Act meant to the American Cancer Society and on what's next in the fight.
ACS CAN marked the anniversary with a call to action to advocates asking them to help ACS CAN make sure lawmakers continue funding cancer research and prevention programs. In addition, ACS CAN released a statement marking the historic milestone on December 13, upon the introduction of a US Senate resolution recognizing the anniversary. ACS CAN used the opportunity to call for the nation to renew its commitment and redouble efforts to find answers, particularly for the deadliest cancers for which early detection tests and more effective treatments are needed. Also read an op ed by Society Chief Medical Officer Otis W. Brawley and watch an NBC Nightly News story on progress made over the past 40 years and the work that remains.
Essential Benefits
On December 16, the Department of Health and Human Services (HHS) issued an advisory bulletin outlining policy direction for states on the essential benefits package. Although the bulletin does not have the force of law, it gives states important guidance as they move toward implementation of health benefit exchanges. HHS plans to publish a formal regulatory proposal, but did not indicate when. Read the HHS press release and ACS CAN's statement.
The bulletin says a state will be able to choose a "benchmark plan" for the essential benefit package in its state. The state can choose one plan from among the following:
The three largest plans offered to federal employees;
The three largest plans in the small group market;
The largest Health Maintenance Organization (HMO) plan; or,
The three largest state employee plans.
The choice is about the benefit package only. Cost-sharing (i.e. deductibles and co-pays or coinsurance) associated with the plans are not important at this point. Cost-sharing will ultimately vary from the selected plan depending on the tier (i.e. bronze, silver, gold, platinum), but the benefits will remain constant. HHS indicated that they may allow some variation in benefits from the chosen benchmark plan, but they did not identify how much variation would be permissible or what criteria will it does not have the force of law used in measuring alternatives. Plans can always opt to offer more generous benefit packages.
If a state opts for a plan in its small group market or the HMO option, existing state insurance coverage mandates will automatically be included since these health plans must already provide them. At this time, ACS CAN is uncertain whether state employee plans are required to include state mandates. Federal employee plans do not have to comply with state mandates, but federal employee benefits are very good and are likely to cover every mandate of medical significance.
ACS CAN is cautiously optimistic that HHS' approach will provide a good starting point for developing an adequate benefit package for all. Federal employee health plans provide good coverage for cancer patients. In addition, the largest small group market plans and largest HMOs are likely to provide good coverage. The level of benefits provided state employees is thought to be fairly good, although there are states that offer relatively small benefit packages.
ACS CAN and other consumer groups wrote to HHS soon after the bulletin was issued to ask that them to identify specific plans in each category for each state as well as to provide a copy of each plan's contract on the HHS website, healthcare.gov. A webinar or conference call will be scheduled next month to provide more information and materials to the field. For further information, read the ACS CAN background paper.
Litigation
The U.S. Supreme Court announced the dates for oral arguments on the Affordable Care Act, spreading them across three days in March. On March 26, the justices will hear one hour of debate on whether challenges can even be brought to the law since the individual mandate at the center of the case has not yet taken effect. The following day, March 27, will be dedicated to the constitutionality of the individual mandate, with two hours allotted for arguments. On the final day, March 28, 90 minutes have been set aside to consider the issue of whether the law's other provisions can continue to be implemented even if the individual mandate is ruled unconstitutional. Following that, the justices have allocated another hour to hear arguments on the constitutionality of the law's Medicaid expansion.
The American Cancer Society and ACS CAN, along with our preventative health partners, the American Heart Association and the American Diabetes Association, plan to file a friend-of-the court brief to point out how dependent the insurance reforms in the law are on the individual mandate, as was done at the appellate level. The brief, due January 13, will also provide the Court with the voluminous data the Society has on the link between having adequate health insurance and health outcomes.
In the States
Over the past year ACS CAN and Society Divisions were very active in the state implementation process, providing leadership on policy matters and acting as consumer watchdogs to ensure the needs of cancer patients and their families are met. To date, 11 states -- California, Colorado, Connecticut, Hawaii, Illinois, Maryland, Nevada, Oregon, Vermont, Washington and West Virginia -- and the District of Columbia have passed such legislation. Another 10 states - Alabama, Alaska, Georgia, Indiana, Mississippi, Montana, North Dakota, Rhode Island, Virginia and Wyoming -- have taken action to move the process forward either through executive order or legislative action. This year will prove no different as most of the remaining states try to pass legislation in time to meet the federal government's January 2013 deadline. (The federal government will operate exchanges in states with no exchange.) Even those states that have already enacted exchange laws will continue to demand attention with a host of regulatory and other issues left to resolve.
ACS CAN continues to support Division advocacy in its efforts to implement the Affordable Care Act in their states. Most recently, training sessions for staff were held in Indianapolis and Washington, DC to release new policy resources, discuss new regulations, share best practices, and work on developing implementation campaigns. A third staff training opportunity will be held in Denver on January 10-11, at which point all Divisions will have been provided an opportunity to participate.
Prevention and Public Health Fund
On December 15, more than 40 leading groups from the public health community, including ACS CAN, are on Capitol Hill participating in more than 70 meetings with members of Congress to remind them of the importance of the Prevention and Public Health Fund. The Prevention and Public Health Fund was established under the Affordable Care Act and set an unprecedented investment to promote a healthy nation. This year, the Prevention Fund allocated $1 billion to communities in every state, and over the course of its first 10 years (FY 2010-2019), a total of $15 billion in proven effective ways to keep Americans healthier. However, the fund has been threatened numerous times by the White House and Congress who are looking to reduce or even eliminate funds. Read more about the event on the Cancer CANdor blog.
Medical Loss Ratio
In mid-December HHS released the final rule governing medical loss ratio (MLR) calculations, the percentage insurers spend on benefits versus administrative costs. The Affordable Care Act requires insurers to spend at least 80 percent of their premium revenue on health care claims and quality improvement costs. Beginning this year, insurers who miss the target are required to rebate the difference to policy holders. Overall the rule is favorable to consumers and maintains the inclusion of insurance broker and agent fees in the calculation as administrative expenses. ACS CAN strongly supports this aspect of the rule, believing that classifying fees and commissions as administrative expenses more accurately reflects the proportion of spending by insurers on health care services.
Accountable Care Organizations
On December 19, HHS announced the selection 32 health care groups in 18 states and covering various geographic regions to participate in the "Pioneer" Accountable Care Organization (ACOs) initiative. The Affordable Care Act requires the creation of ACOs, which are groups of providers and hospitals that agree to come together to deliver higher quality care at a reduced cost. ACOs will be paid bonuses for saving Medicare money and performing well on certain quality measures.
ACS CAN acknowledges the potential of ACOs to improve the health and quality of care for cancer patients and is pleased that the final regulation governing ACOs supports a strong foundation in primary care; incentives to deliver more coordinated, integrated care to patients with chronic diseases such as cancer; and ongoing performance monitoring to improve quality. ACS CAN will continue to monitor ACOs and other delivery reforms to assess their impact on cancer patients.
Coverage for Young Adults
HHS announced recently that more than 2.5 million young adults under the age of 26 have been able to stay on their parents' health insurance plans due to a provision in the Affordable Care Act. This number was larger than expected and represented an increase in the amount of insured young adults from 64 percent in September 2010, when the provision took effect, to 73 percent in June 2011.
Final CO-OP Rule
HHS released the final rule on Consumer Oriented and Operated Plans (CO-OPs), private, non-profit health insurers with a board made up primarily of CO-OP plan members, designed to offer quality, affordable health plans in every state. CO-OPs were created through the Affordable Care Act to provide more competition and choice to consumers and would be available through a state's health exchange.
School-Based Health Centers
HHS awarded more than $14 million to 45 school-based health centers across the country this week. The funding was authorized by the Affordable Care Act, and will allow school-based health centers across the country to expand their capacity and modernize their facilities. The funding will allow the centers to treat nearly 53,000 additional children in 29 states.
FAMILY SMOKING PREVENTION AND TOBACCO CONTROL ACT
Orange Bowl
Following intense pressure from the Society, ACS CAN, its public health partners, and the public at large, the Orange Bowl Committee and the National Collegiate Athletic Association (NCAA) canceled a three year deal with Camacho Cigars to sponsor the Orange Bowl and related events. On December 20, the Society and ACS CAN, together with several public health partner organizations, sent an open letter to the Orange Bowl Committee and the NCAA arguing that the cigar company's sponsorship would entice teenagers, and especially young men, to smoke. Soon after, several US senators also called for the sponsorship to be dropped. Read the joint press release and The Washington Post story.
Camacho Cigars' attempt to sponsor the Orange Bowl is the latest example of the tobacco industry's attempt to undermine the Family Smoking Prevention and Tobacco Control Act (FSPTCA), which bans cigarette and smokeless tobacco brand sponsorships of sports event sponsorships. Cigar company sponsorships are not specifically mentioned. Under the law the Food and Drug Administration (FDA) has the authority to regulate cigars and extend provisions such as the ban on sports event sponsorships to cigar companies. ACS CAN and its coalition partners have been urging the FDA to assert its regulatory authority to cigars since the FSPTCA passed in 2009. Cigar smoking is the second most common form of tobacco use among youth, after cigarette smoking. About 14 percent of high school students - including 18.6 percent of high school boys - smoke cigars, according to the Centers for Disease Control and Prevention.
Indiana Governor Mitch Daniels, after years of refraining from pushing for a statewide smoke-free law, recently said he would make the issue a priority for the 2012 legislative session. Much credit is due to the Great Lakes Division and ACS CAN, who have been at the forefront of the effort to enact a comprehensive statewide smoke-free law, diligently building momentum through passage of local ordinances, securing support for the issue in the legislature, and raising public awareness. In addition, ACS CAN heightened attention to the issue by publishing voter guides stating the positions of the Indianapolis mayoral and city council candidates on whether to expand the city's smoke-free law to cover all workplaces, including bars and restaurants.
Indiana is just one of several states where ACS CAN is making passage of a comprehensive statewide smoke-free a priority as part of its "Red to Green" smoke-free initiative to change "red" states with no statewide smoke-free law into "green" states that ban smoking in all workplaces, including bars and restaurants. ACS CAN will also be working in 2012 to defend against the efforts of the tobacco industry and others to weaken or repeal existing smoke-free laws.
DRUG SHORTAGES
Following up on President Obama's executive order addressing the drug shortage problem, the Food and Drug Administration (FDA) issued an interim final rule clarifying drug companies' obligation to inform the federal government about plans to discontinue a drug or about disruptions in a manufacturing a particular drug that could result in a drug shortage. The Society and ACS CAN are actively engaged with other stakeholder groups, including Congress, the Administration, and generic and name-brand pharmaceutical companies, to better understand the causes of recent drug shortages and possible solutions. ACS CAN has also endorsed a bill in Congress addressing the issue. In addition, the Society's National Cancer Information Center in Austin, Texas, is now tracking calls from patients who have experienced drug shortages and the Society and ACS CAN are asking Divisions to collect patient stories. An ACS CAN fact sheet is attached for further reading.
Chris Hansen | President of ACS CAN
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.